Long-term work capability 6 years after spinal arthrodesis for adult deformity vs. degenerative disease: Clinical, functional, and occupational outcomes

2015

Introduction
Can patients work long-term after spinal fusion? What type of work can they do?  Occupational outcomes have not been well studied in the non-work compThis study compares the clinical, functional, and occupational outcomes in patients after short fusions (SF) for degenerative disease vs. long fusions (LF) for spinal deformity. 

Methods
A retrospective review of 201 consecutive working patients age 52 years (20-80years): 75 LF vs 128 SF patients.  Excluded: workers comp, students, unemployed, retired. LF diagnoses: adult idiopathic scoliosis-37, degenerative scoliosis-16, kyphosis-21. Length of fusion for LF patients averaged 8.6 levels (range 4 - 16 levels). SF diagnoses: degenerative disease-60, spondylolisthesis-66 were fused 1-2 levels only (average 1.4 levels).  Work type defined: sedentary, light, medium, heavy.

Results
At average follow-up 6 years (24-106 months), 183/201 (91%) patients were still working; 119/126 (94.4%) SF and 64/75 (85.3%) LF patients. Weeks to return to work: LF- 18, SF-13. Obese patients less likely than normal to work long-term (p=0.089). No effect on long-term work: Age, sex, diagnosis, fusion length, work type. SF returned to work faster than LF (p=0.05). Post-op change to easier work: 21/182 (26%): Heavy-53%, Moderate-19%, Light-12%; Change to heavier work -11/182 (18%).   LF group had more pre-op sedentary jobs (44% vs. 51%) and none at heavy work long-term. VAS improved LF: 5.1 pre-op to 3.16 at 6 years (p=0.004); SF: 6.4 pre to 2.9 at 6 years (p<0.001). ODI improved for LF: 38.9 pre-op to 22.0 at 6 years (p=0.0042); SF improved 45.9 pre-op to 27.5 at 6 years (p<0.001). Pain med use declined for both groups. There was no difference between SF and LF groups in ability to return to work (p=0.247).

Conclusions

Workers undergoing fusion for spinal deformity have less pre-op pain and can reliably(85%) return to work and remain working long-term similar to SF patients. Long-term outcomes and work status are similar for LF and SF patients.

Significance
Deformity patients can be assured they have an excellent chance to return to work and remain working long-term after LF.

Summary (80 words)
The ability of 201 working patients (non-work comp only) to remain working long-term after spinal fusion was studied: short fusion for degenerative disease vs. long fusion for deformity.  Though short fusion patients returned to work earlier (13 vs. 18 weeks), there was no difference in ability to remain working long-term (85-94% at 6 years follow-up).  Both groups significantly improved VAS and ODI long-term. Age, sex, diagnosis, fusion length, and pre-op work type had no effect on long-term ability to work.